Death: Reflections of a Surgeon

By Dr. Munir A. Cheema

Its both moving and wonderful. I enjoy it too much to put it down for long. I read through the entire work spellbound, reflecting on how rare it is to encounter reading material that both entertains and instructs.

Despite its title, the book is more about life than about death. For sure, the book is filled with pearls of wisdom regarding the ultimate and final journey that we all take. But the informal and anecdotal nature of the story renders it just that: a story of how death should be viewed through the lens of life.
Prof. Stephen Thomas

• Language: English
• Publisher: Xlibris US
• Release date: May 21, 2016
• ISBN: 9781514484722

Dr. Munir A. Cheema

The very title is thought-provoking and captivating. When a thought enters the mind – while awake or even asleep; it can become an inspiration – and can take you to sublime heights; in poetry, prose, art or science. It is creative way of handling thoughts in general, especially the profound ones. Professor Dr. (Brigadier) Munir A. Cheema is a prolific writer. His usage of English is excellent and his way of writing and expressing himself superb. Being a senior army officer, he has been trained to be highly disciplined, meticulous and keen observer. His writings captivate the reader and the stories or anecdotes he has chosen to pen down are revealing. As a matter of fact, while reading some of the anecdotes, I felt like I was reading the “Bostan” and “Gulistan” of Shaikh Sa’di of Shiraz. These are expressed in the same simple way but with far-reaching, useful moral outreach. He is very candid in his writings and, just like Sa’di, advises that often silence is golden. He very candidly advises to keep shut, if you are not sure what you are going to talk about. He does not hesitate to call a spade, a spade and always takes the bull by the horns. For some people, writing can be arduous, but it flows like a calm river from Dr. Cheema’s pen. I am sure that, whosoever reads this book, will take away something from it and perhaps be a better human being. Prof. Dr. Munir A. Cheema is a surgeon with empathy; a trait so far was taken for granted in medical students. But it is so fast vanishing that now it has to be taught in medical schools as a separate subject!

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Copyright © 2016 by Dr. Munir A. Cheema.

Library of Congress Control Number:  2016905952

ISBN:  Hardcover  978-1-5144-8474-6

Softcover  978-1-5144-8473-9

eBook  978-1-5144-8472-2

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Rev. date: 05/20/2016

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Contents

Foreword

Preface

Introduction

’TILL DEATH DO US PART

1. Death of a President

2. A Woman with a Mission

3. Principled Principal

4. Truthfulness

5. An Anglicized Pashtun

6. A Perfect Gentleman

7. Elegance pars excellence

8. Cutting for stone

9. Larger than life

10. An Honorable Man

11. Life in the Army

PRESCRIPTION FOR A WORTHWHILE LIFE

12. Fear of impending death

13. How to die gracefully?

14. The Faith

15. Empathy The Emotional Intelligence

16. Friends

17. Kismet

DEATH THE GREAT EQUALIZER

18. Life before Death

19. The secrets of old age

20. Epilogue

Some people have demeanor eminently suited to lead funeral processions, drawing of wills and writing obituaries

Foreword

Dr. Munir Cheema my teacher, mentor and a friend is an accomplished Surgeon and an inspired writer. His first book RAMBLINGS established his unique style of direct and freelance dialogue with his readers. Present literary work by him has even more nurtured style.

This book that started as obituaries has transformed into rumination of the writer. Coming to terms with his pains of loss of his friends. Reminiscing them seems to have opened up his own mind to certain complex concepts of life and death.

Percolations of his thoughts through these events have engendered second and third parts of the book. The wisdom that has emerged is in the form of several chapters on relationships, conduct of life and preparation for the hereafter. The net essence of it all has been embodied in Epilogue.

Those of us, who have the good fortune of enjoying his company, know that all his inquisitiveness and at times searching interactions with those around him actually is a process to understand and crystallize his own thought process. This book is a ready evidence of this phenomenon.

This philosophical piece of literature from his lifelong experience reveals his curiosity in trying to fathom matters of life and death.

WAJID ALI

FCPS

Consultant Physician

Preface

To write Foreword of my first book Ramblings I invited two illustrious Harvard professors. For the present book I have asked an outstanding physician, who deems himself my student; from whom I have learnt much. Dr. Wajid Ali is an eminent physician groomed by Prof. N K Burki now at Yale, CT. USA. He was a physician in the army and since retirement we are colleagues in the same teaching hospital.

Unbeknownst of recently acknowledged method of teaching: Socratic method of teaching, I had been practicing it all my life. It seemed so natural. I am happy to note that I am in good company. Socratic method entails; instead of one-way traffic where teacher bombards and blitzes, here he involves his students by asking them questions. This time-tested method has many advantages. First you can assess where the students’ minds are wandering. And how much the students understand the subject and if they are at the same wavelength as their teacher. Also at the end of the lecture it will surprise the teacher, how much he or she has learnt from the students. This book has the same style; more questions than answers!

The book is not to pontificate, but it points towards the frailty of man. We plan our lives as if we will live forever; whereas death is only a heartbeat away. We plan for years; for our children and then children’s children. I have a friend who selected a panoramic top of a hill for building a custom made citadel to live happily ever after. He spent millions to construct the palatial palace. The view from his balcony is so scenic and serene; overlooking woods and a meandering river that it indeed is a view to heaven. He is there right now!

He lived in the house for less than five days. He died a tragic death by falling in the shaft of his elevator.

This book counts many blessings. When I look wistfully at the face of a friend who is still alive, my apprehensions are; there may not be a next time. Munir Niazi, a great poet has described my feelings very well. ‘Hamaisha dair kar daita hoon mein.’ Alas! I am always too late. We keep on waiting for the right moment to express our yearnings. There is no right or wrong moment. It is here right now. Reach out and touch some one’s heart.

The life story of Steve Jobs fascinates me and I have referred to it time and again as to what destiny is all about. He was an Icon who revolutionized the world of communication, but had rather a checkered childhood. He died prematurely for not being able to make a right decision; based neither on intellect nor intuition. On the other hand there are the Indian villagers whose mode of decision-making is intuitional. With little knowledge they seem to live fairly contented lives. Ignorance seems a bliss.

But then do we have control on such matters, or naively keep treading on the dotted line?

Munir Cheema

Washington DC

8th January 2016

Introduction

What is life? And what is death? Ever since Adam and Eve, philosophers and even common folks have been trying to unravel the riddle; but to no avail. And the debate goes on and will, till the doomsday—may be even beyond!

The beauty of poetry is that the poets make such complex matters look so simple.

Zindigi kia hai, an’asar mein Zahoor-e-tarteeb

Moat kia hai, inhi ajza ka paraishan hona

Life is, a fine equilibrium of ionic harmony

And death, this arrangement gone astray

Not being a biochemist how could Ghalib and in primordial times, envisaged, a vision of life and death based on balance of electrolytes like Sodium, Potassium and homeostasis is indeed astounding. This is scientifically accurate for all life at cellular level; including animals and plants. How could he figure out such a complex matter centuries before the scientific unearthing. It has to be a divine inspiration!

Biologically life is dependent on chemicals, which through mysterious permutations generate energy. ‘Energy that helps life struggle—a process of recognizing and trying to overcome challenges, sometimes succeeding and sometimes failing.’ Health is reliant on delicate equilibrium of electrolytes. Health is a splendid gift that makes us live and experience tender feelings like love and passions. Due to myriad of chemicals, there are indescribable kaleidoscopic patterns---awesome and amazing, documented by scientists, physiologists and biochemists. Because of it Louis Armstrong could celebrate, It is a wonderful world. I see trees so green and roses too…. Because of it man has accomplished so much—in science, medicine, arts, exploration of space and beyond.

Ab muntazare shore qiamat naehin Ghalib

Duniaya kae her ek zarae mein ik hashr bap’a hai

Now I do not have to wait for dooms day to perceive mayhem

I can see an intense turmoil splitting the heart of each atom

Life is in a constant flux; from electrons to celestial stars. Panta rei.

And death is just the reverse of it. Still and silent--hush like in a cemetery. Biologically death is derangements of same elements. The disorder and its effects take death to quite a different stratosphere. Death is epitaph of man’s struggles and swagger. The after-shocks tilt death beyond human perception. It moves into a quite a different realm and dimension—soul and spirit. It leaves a lasting void in the milieu the man lived in. Death for next of kin is devastating. For physicians death is a tragedy. When one of their patients dies, treating doctor’s commitment with the patient determines their level of pain and sorrow. Physicians have feelings of remorse at the death of a patient but their sufferings relate only to acts of omissions. For the surgeons it is not only acts of omission but also acts of commission—doing too little too late, or doing too much too soon. The death is ascribed to surgery performed by the surgeon. Nothing is more agonizing for the surgeon than to face a post-operative death. A part of him dies with the patient and facing next of kin is an ordeal that a surgeon will do anything to avoid. No rationalism or reasoning can stand before passions. Statistics to the relatives that your other 99% patients survived is no solace to them. In case of death surgeon has to carry baggage of losses of every affiliate of the team; anesthesia, operation theatre, nursing, the post-operative care and all sort of deficits; the poor fellow has even no control on. Except for surgeon everyone else is shielded under cover of hospital conglomerate and no one else can perceive how much compassion is involved in the death of a patient. It is at the door of the surgeon the buck stops.

After my fellowship in surgery in early sixties I was musing with the idea of selecting which specialty to choose. So I spent a few months rotation with different subspecialties including cardiac surgery. Cardiac surgery and anesthesia those days were rather elementary and there were lot of table deaths particularly of young children born with congenital malformations. I cannot forget the predicament of the surgeon after a death. He did not know how to sneak out of the operation theatre evading the next of kin of the dead children anxiously waiting outside; leaving the damage control to his junior staff. And how we used to manage the situation and still survive: I have no heart to recall. The lesson learnt was that I gave up the idea of ever becoming a cardiac surgeon.

How death touches different people depends upon their degree of involvement with the deceased. Patients are dying every day in hospitals and the staff cannot afford to sit down and mourn; they have more important urgent tasks at their hands. Death hurts most the next of kin---the near and dear ones. What it appears to the rest is just another death. For the undertakers who prepare the dead to fit in a casket and for the preparation of the Hearst, death is just another job. In hospitals, for the disposal of the dead body medical staff is not involved. It is usually the responsibility of the paramedics and porters. How they can be so indifferent and unconcerned about death amazed me, when I joined an English hospital soon after my graduation where I was trained to be a surgeon.

"Here, even the porter of the hospital commanded great admiration. He was omnipotent and a handy man. In his spare time and in emergencies he would stand for the receptionist, telephone operator, transport patients and prepare death and cremation forms. He did all sorts of all odd jobs. He was the most well informed person who knew all about the scandals and inside stories of the hospital. It was important to be on his right side. So I soon found out.

An Indian doctor was working in the (ER)--Emergency Department that was open round the clock to receive emergencies. All sorts of people thronged the place. It was difficult at times for the casualty medical office to admit a patient unless he or she was a real emergency; otherwise the registrars who regarded hospital beds as their personal property would lynch him. There was no way one could admit a patient with a common cold or a sprain ankle in the hospital and get away with it. There was always shortage of beds in the hospital. It was quite usual to have scores of drunks brought to hospital every Friday night. Some time it was difficult to tell who was suffering from a real medical problem when the patient was not sober. The casualty medical officer had to be very careful that he did not send away a seriously ill patient home—to die. It would be scandalous; in fact lethal particularly for a foreign doctor.

An elderly patient arrived in hospital in the dead of a night with shortness of breath and chest pain. The duty medical officer was in two minds about admitting the patient. If he were not a cardiac patient the medical officer would have to face the wrath of an irate Registrar. On the other hand, if he sent the patient home and something happened, it would be disastrous. The medical officer remembering previous unpleasant encounters with the registrars chickened out. After giving him some medicine he very reluctantly sent the patient home. The ill at ease, exhausted medical officer then went to his room to snatch some sleep after a hectic night. Next morning the porter met this doctor in the corridor of the hospital and informed him, Doctor, that patient you sent home last night died of a heart attack soon after he left the hospital. The casualty medical officer was taken aback in and stunned. He immediately thought of losing his job and his medical insurance and his license to practice medicine, as the GMC in England applied the rules very strictly; unlike in our country, where